Maria Pokluda with Cut It Out author Theresa Morris
I am passionate about helping women find and receive evidence-based care, so it comes as no surprise that I jumped at the chance to listen to author Theresa Morris speak about her book Cut It Out – The C-section Epidemic in America. I was also lucky enough to connect with her afterwards and chat about the book, her own birth experiences and, something we have in common but has nothing to do with Cesareans, parenting teenagers. Dr. Morris is warm and friendly and I liked her instantly but at that time I had not actually read the book, only reviews from the New York Times and other sources. However, I grabbed a copy as we talked (and had it autographed of course) and put reading it on the top of my to-do list for the following week.
Cut It Out is both an academic read and one that is very practical for expecting women and those that serve them. So often the conversation about Cesareans gets simplified to the notation that OBs (and to some extent, midwives) just want to do surgery so they can be home by dinner or to hit the golf course. As a doula, I hear lots of derision in this regard casting OBs in negative light. Or, to the other extreme, higher Cesarean rates are blamed on women being older, bigger, and overall less inclined to want vaginal births, often even opting for Cesarean deliveries with no medical reason with a “too posh to push” attitude. Dr. Morris dispels both of these ideas quite decidedly. In fact, while I have never been one to solely place blame on the care providers, after reading the book I have a much more acute sympathy for how care providers, like women, are part of a system that is currently out of their control.
The question asked in Cut It Out is: How is that Cesarean rates are at an all-time high despite very solid evidence showing that Cesareans are less safe for women and babies and have not improved outcomes in terms of mortality and morbidity? Dr. Morris approaches answering this question from an organizational perspective addressing how the systems involved work together to take away the individual choices of both women and care providers. She identifies the root of the problem as the overall concern for liability and then addresses the organizational structures that are in place to deal with that threat. She believes the risk of being involved in a lawsuit is the overriding concern of a hospital and that is passed down to the care provider, the nurses and everyone involved. The paradox is that research shows Cesareans are associated with a higher risk of injury or death for both women and babies, but that this type of harm does not pose a liability risk and thus is better accepted by institutions that wish to remain in operation and not embroiled in legal tangles.
Dr. Morris is sympathetic to all involved. Women are not shamed for their Cesareans, care providers are not scorned for doing Cesareans. She states it is “not only women who have their choices limited. Rather, the crux of the problem…is that organizations determine the choices of women and maternity providers, and these constraints lead to an exceedingly high C-section rate” (pg. 4, Cut It Out). She does offer a “Roadmap for Change” of excellent practical advice for expecting women, for hospitals, and for long-term societal changes with regard to maternity care. I would be remiss to not mention that her “Solutions” suggestions aimed at expecting women are EXCELLENT and in line with the things I discuss with my clients including their access to VBACs. I was also tickled (but not surprised) that hiring a doula is one of her suggestions. I knew I liked this woman!
Want to read the six suggestions for expecting women or the rest of her “Roadmap for Change”? You can find the book on Amazon because I don’t want to lend out my autographed, and now heavily marked up, copy. This is a book I am going to refer to time and time again!